Therapeutic Craziness: A “Family Group Psychosis” Case Reflection

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DK: Here’s an example of a case which illustrates how the Family Group Psychosis works. (See post from 6/6). This case demonstrates the therapeutic (changeful) benefit in expanding the family as part of the therapeutic project. My hope is to elicit a sense of “We are an Us”. A consultation interview with an extended family can take many turns. Some consultation interviews are dramatic. Some are uneventful and even discouraging. Most often the sessions have an effect on consciousness and while the effects are not put into words specifically, there is an energetic change that shows up in a shift in behavior or in awareness.

A crucial factor in setting up such an interview is to keep in mind that the patient or family in therapy have decided to become patients. They have decided to seek help in their effort to repair something about themselves and their relationships. When the extended family is invited in, I don’t bring them in to be patients. They come in as consultants. That is they come in to help me help the family who are my patients. They do that by responding to my questions about what the family is like, but not in the present. In the beginning I go backwards in time to get a sense of where the family comes from. How did the 70 year old parents grow up? I do not talk specifically about the reason the family is in therapy. However, often when we get further into the interview I may ask the grandparents how they think about what is going on in the present family.

My assumption is that both problems and health are in the process of the family.  In the following iimages-9llustration, nothing much gets nailed down. There is no obvious conclusion, instead there are atmospheric changes, shifts in consciousness, not always easily articulated.  Thinking and perception is disrupted in a context of caring. The effects are not based on strategy by the therapist.

The Case: The Jackson family consisted of Bill, 47, an endocrinologist, Elaine, 43, who worked part-time as a mathematician for a software company, and their three daughters, Anne, 18, Kim, 16, and Taylor, 12. I (plus co-therapist) began working with them approximately 18 months before the extended family interviews described in this essay. They sought therapy because Kim had an eating disorder. Five years earlier, the mother Elaine entered alcohol treatment, one and a half years after the death of her sister from lymphoma.  Two and a half years earlier, the middle daughter, Kim had been hospitalized for 6 weeks because of anorexia.

After discharge, Kim continued in individual therapy with an eating disorder specialist and received antidepressants from a psychiatrist until the family started working with us. She continued to be bulimic, restrict intake, and eat alone; she was becoming steadily more defiant and her school performance was uneven. Kim’s eating problems (bingeing and vomiting) and her depressive symptoms agitated her mother. The father was most upset by her defiant behavior. We began a series of thirty interviews over twenty months.

images-7In June, more than a year after the first interview, the parents, most particularly father, complained about no progress (an impasse). In fact, in my view, Kim’s defiance was a symptom of health, although problematic for the parents. Her defiance kept the father involved. The daughters’ sense of themselves as a group had increased, thus Kim was less isolated. It was no longer Kim against everyone.

In an effort to stimulate the therapeutic momentum, I suggested the background families come in for a consultation visit. The mother was reluctant for reasons not entirely clear. She was uneasy about something unarticulated in her family.

The Extended Family: To my surprise, Bill, the father, who never seemed emotionally engaged, invited his family-of-origin in near the end of August, including his own father and mother and younger sister, aged 38. I saw them with the whole Jackson family who were my patients. Bill’s family of origin was down to earth, tender, and loving. His father was a retired heavy equipment operator, a gruff man with a dry sense of humor and earthy intelligence. They were storytellers and told some humorous anecdotes and some sad painful ones. For example, Bill’s mother gave birth to a dead baby when Bill was approximately four years old. All reflected on that experience and the differences the death made in their lives. They were sweetly unimpressed by their son’s success as a physician. Bill’s family of origin was different from what I expected; they were warm and enjoyed one another. It was surprising that Bill was such a concealed “stuffed shirt” in the family he was raising.

Interestingly,  Kim, the anorectic middle daughter, who tended to be surly during our family interviews, was remarkably sweet and affectionate with her parents and grandparents during this interview a startling difference in her demeanor. I hadn’t seen that kind of loving behavior in the Jackson family. Two weeks after the interview, Bill brought an intriguing, small, rustic, abstract painting of a boat from his office. He talked about what it meant to him. It had the quality of a transitional object for an adult. Bringing the boat was a subtle symptom of him being more self-revealing, more personal, more engaged in the therapy. It suggested he had become more of a patient. In my thinking, this was evidence that an exuberant version of the Family Group Psychosis had occurred as a result of the interview. It suggested he had been put in touch with his family’s “we.” More of the Bill became available to the therapeutic work.

images-10After that positive  experience, Carol decided she would get her family to come in. She was eager and ambivalent in equal measure. We arranged for a date in October. On the appointed day, only the Jacksons arrived; Carol said she “forgot” to tell her family of origin about it. This was incongruous with her usual careful and responsible ways.

At that interview, as an explanation for her uneasiness, Carol talked in more detail about her family of origin. She was the oldest of five children. One brother was estranged, possibly gay and probably alcoholic, another brother worked with her father, a younger sister, who did everything right, was married and had a young child. Another sister died of lymphoma seven years earlier. It was at the time of her sister’s death that Carol became aware of her own alcoholism. She entered treatment 18 months later. Her mother, 76, had been a gifted college student who gave up a promising professional career to marry. Her father, 74, was an electrical contractor, who had done well in the 1960s and 1970s, but business had gone poorly and he had not done a good job of transferring the business to his son.

It felt like Carol’s family of origin had been introduced to our therapy. She agreed to bring them in “live” at our next meeting in two weeks.

              To be continued…Carol’s Family




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